Scandinavian Journal of Public Health

Gro Harlem Brundtland, former Prime Minister and leader of the labour party of Norway and also an MD and MPH made the following remarks at a so-called Harvard Public Health Alumni Seminar in Oslo, April 6, 1984.

We have asked the former professor of internal medicine at Karolinska Institutet in Stockholm currently an MP for the Conservative Party to respond to the article on privatization of services written by Gro Harlem Brundtland.

The validity and reliability of interview reports on rheumatic disorders in a Swedish nationwide health survey were studied. Two samples, including altogether 157 individuals, who had reported rheumatic disorders, were medically examined 6 to 24 months after the original interview. The reproducibility of the original interview was studied by the means of two re-interviews. The proportional distribution of rheumatic disorders according to diagnostic group was similar to that in the original interview, in the two re-interviews and at the medical examination. In a subject-to-subject comparison the overall agreement between the medical examination and the lay re-interview was 84% (kappa 0.35) regarding presence of rheumatic disorders, and 57% (kappa 0.41) regarding matching of rheumatic diagnostic groups. In the original interview and the lay re-interview the same individual rheumatic disorder was reported by 38% of the subjects; 58% agreed regarding rheumatic diagnostic groups. The interview reports on rheumatic disorders in the health survey can therefore be considered to have acceptable validity and reliability only with regard to the proportional distribution of groups of rheumatic disorders, based on aggregated data.

A record linkage was performed between the in-patient register of Stockholm County and the Stockholm County sample of a national health interview survey. The purpose was to describe and compare characteristics of the two registers, particularly as regards rheumatic diseases. All persons included in the health interview survey of 1977–78 were sought in the in-patient register for the same period. 37% of the population had reported long-term illness in the health interview survey and 22% had been hospitalized, according to the in-patient register. 11% reported a rheumatic disease in the health interview survey, but only 2% were hospitalized with a rheumatic diagnosis. Persons who reported a rheumatic disease in the health interview survey were compared with persons hospitalized with a rheumatic diagnosis by using items in the health interview survey on perceived health, physical mobility and work capacity. The most important difference between the groups was a much higher proportion of disabled persons in the hospitalized group. Perceived health was reported very similarly in the two groups. The reports on hospital episodes in the health interview survey were validated against the in-patient register. An under-reporting of 13% and several inaccuracies in the timing of the hospital episodes were found.

The article is an account of physical activity at work and during leisure time in a Swedish rural county based on a cross-sectional study of a selection of 7986 individuals in the age range 25–75, at 5-year intervals. 70% of the men and 71% of the women participated in the study—carried out in the spring of 1977—comprising a health examination and a combined inquiry/interview poll. 50% of the men and 22% of the women perform either moderately heavy or heavy work, with little variation between age groups. 20% of the men and 8% of the women engage in regular physical exercise and hard training. 14% of the men and 15% of the women are inactive during their leisure hours. Physical activity at work and physical exercise habits vary in different municipalities. Thus in the rural districts, physical activity at work is greater than elsewhere. Any differences between municipalities disappeared after adjustment for age, sex and occupation. Greater physical activity at work is positively correlated to somatic disturbances, one being a high diastolic blood pressure. A high level of physical activity in leisure time is correlated to low total morbidity of somatic disorders and fewer mental disturbances—irrespective of age, sex, physical activity at work and socioeconomic group. An astonishing finding is that there is no correlation between physical activity during leisure time and at work. Nevertheless, there are differences between socioeconomic groups regarding physical activity during leisure hours. Civil servants are those characterized as most active.

As part of a research project concerning repeated short-term sick-leave an intensive study has been performed aiming at estimating the frequency and character of psycho-social problems in a population with a minimum of six short sick spells during a 12-month period, in comparison with an age- and sex-matched sample of patients who went to the local general practitioner in the same area. The results show that psycho-social problems are twice as common in the group with repeated short-term sick-leave.

The investigation group included all 1313 employees of SAAB-SCANIA, Linköping, in the age group 50–59 years. In 1975 they were called during their working hours to the company's Physical Training Centre to be assessed. This investigation included measurements such as systolic blood pressure, height, weight and certain anthropometric measurements. Other information was obtained from the personnel records about sex, age, type of employment, educational grade, degree of responsibility, and reported sick leave in 1974 and 1975 for the workers, and between 1970 and 1975 for the salaried employees. The total number of drop-outs was 238, or 18%. Sick leave is mainly a problem of the long-term absence of a minority of employees with an ever-increasing rate of absence. Sick leave among the salaried employees decreases in relation to higher education and increased responsibility. A high level of responsibility and education characterizes a low-risk group, whereas little responsibility and a low level of education denote a high-risk group with regard to blood pressure and sick leave. A disparity—low education and medium responsibility—has earlier been described as denoting a high risk of psychosomatic diseases. In this study they showed a rate of absence lower than the average at the same time as the blood pressure is above the average.

The association of self-reported use of alcohol with blood pressure and compliance with antihypertensive medication was studied in a randomly selected population sample in eastern Finland. We found a positive correlation between reported use of alcohol and diastolic blood pressure level and a negative correlation with the reduction of diastolic blood pressure during a five-year treatment. These correlations were independent of age, gender, and blood pressure level 5 years earlier. The use of alcohol was associated, especially in men, with poor compliance with antihypertensive medication. In addition to a possible direct contribution to high blood pressure, alcohol intake resulted in an inadequate control of blood pressure in male hypertensive patients by lowering patient compliance.

This is the first part of a longitudinal follow-up study of 218 consecutively sterilized women. The operations were performed at the Gynaecological Department of Akershus Central Hospital during the period May 22nd 1973 to February 1, 1974. The mean age of the women was 33.5 years, their mean parity 2.8. They could not be distinguished from the women of the same age in the county at large with regard to incomes, education or housing conditions. The usage of contraception was widespread, but not consistent. Fifty-eight per cent of the operations were performed postabortion, 69% of the women had at least one, 21% at least two induced abortions before the sterilization. Family planning was the predominant stated motive for sterilization, and the present study indicates that the sterilization legislation of 1934 was outdated some years before it was succeeded by a new law. Sterilization was suggested by the doctor in 40%, at abortion application in 30%.

Six years after their sterilization, 206 of 216 consecutively sterilized women were interviewed. Included in the semistructured interview was a series of questions about their more general attitudes to tubal sterilization. Half of the women considered the early thirties the appropriate age for contraceptive sterilization. Sixty-four women argued for male sterilization, 59 for female. The protagonists for vasectomy were younger. Twenty-seven women said contraceptive sterilization should not be more widespread, 38 believed postoperative regret was common. The abortion situation was considered inappropriate in the discussion of sterilization by 66 women; 131 found it sensible. While 84 women considered the new, liberal sterilization legislation an improvement, 110 did not agree, mainly because they considered the age limit of 25 years too low.

To develop the functions of a health care system it is essential to compare and evaluate the systems of different countries. The World Health Organization (WHO) has emphasized the importance of collaborative studies in the field of epidemiology. In countries with similar social systems the basis for health care is usually the same. Comparison of health care in such countries is relatively easy because in most cases the criteria for functions, diagnosis, etc. are similar. Comparison of countries having different bases for health care and different philosophies of research is much more complicated and time-consuming. Soviet health care, including oral health care, is based on community responsibility and has complex prophylaxis as its main emphasis. In the USSR there are no private dentists. All dental services are available at polyclinics located either near the place of residence or at the work place. In Finland there are two separate systems for oral health care. Children up to the age of 18 and some special groups of the adult population (pregnant women, military recruits, and students) are treated in municipal polyclinics (called health centres in Finland). Otherwise, the adult population is treated mainly by private dentists. The study will be carried out in three towns in Finland and six towns in the USSR. The aim of this study is to describe the causal epidemiology of dental caries among children 6 to 7, 9 and 12 years old in Finland and the Soviet Union. In addition, certain measures and compounds for caries prevention will be tested during 3 years of follow-up. Our results will help the authorities of both countries to develop and replan the functions of communal dental care for the populations included in this study.